Veterinary Surgery最新文献

Objective: To compare outcomes of dogs with gastric dilatation-volvulus (GDV) treated with open right-sided barbed suture gastropexies (BSG) and standard right-sided incisional gastropexies (SIG).

Study design: Retrospective cohort study.

Animals: Client-owned dogs treated for GDV with BSG (n = 58) and SIG (n = 63).

Methods: Medical records were reviewed retrospectively. Suture type and size, surgery time, perioperative complications, and survival to discharge were recorded and compared between groups. Follow up was conducted by medical record evaluation, e-mail, or phone contact. Postoperative surgical complications, recurrence of gastrointestinal signs, gastric dilatation with or without volvulus, and survival time were recorded and compared. Categorical (χ² versus Fisher's exact test) and parametric versus nonparametric (paired t-test versus Wilcoxon Mann-Whitney test; one-way ANOVA versus Kruskal-Wallis) methods of comparison were applied as appropriate.

Results: Perioperative mortality rate was 5.79% (7/121) with no difference between SIG (5/63) and BSG (2/58) (p = .28). Barbed suture gastropexies resulted in shorter surgical times when compared to SIG when performed as the sole procedure (53.3 versus 62.6 min, p = .03). Perioperative and postoperative surgical complications (p = .12), recurrence of GDV (p = .22), or gastric dilatation without volvulus (p = .5) did not differ between groups. Postoperative gastrointestinal signs were reported in 23% of dogs with no difference between groups (p = .33).

Conclusion: Barbed suture gastropexy is a viable option for surgical management of GDV. Persistent gastrointestinal signs remain possible regardless of gastropexy technique.

Clinical significance: Barbed suture gastropexy can result in shorter surgical times with similar recurrence rates to previously reported gastropexy techniques.

Objective: To compare the comfort and functionality of three sizes of laparoscopic ring/finger loop handles during a laparoscopic cup biopsy task and determine which design feature was most associated with comfort.

Study design: Prospective, blinded, randomized three-way cross-over study.

Sample population: Participants (n = 120) at the 2022 American College of Veterinary Surgeons (ACVS) annual symposium.

Methods: Participants performed a laparoscopic cup biopsy task using three differently sized finger loop handles. Participants were blinded to the handles and randomized in their order of presentation. Each participant completed a demographic survey and a post-task four-question survey regarding handle characteristics and preferences.

Results: Female participants had a median glove size of six compared to males with a size seven. Female participants described the small handle as most comfortable (52/81, 64.2%); male participants preferred the medium and large handles equally. Participants glove size predicted the "most comfortable" handle size (p < .001). Both glove size and gender predicted the "least comfortable" handle size (p < .001, p < .045, respectively). Female participants reported that the characteristic "easier to turn dial" was the most important reason for comfort (31/81; 38.3%). Male participants reported that "fingers felt more comfortable in grips" as the most important reason for comfort (15/27, 55.6%).

Conclusion: Surgeons with smaller glove sizes (<6.5) and female surgeons experience more difficulty with commonly available laparoscopic handles. The most important design feature for laparoscopic equipment is dependent on glove size.

Clinical significance: Surgeons should review all available options for laparoscopic handles to improve ergonomics during laparoscopic surgery.

Objective: To determine the ability of abdominal ultrasound (AUS) to correctly identify gastrointestinal foreign body (GIFB) type, location, size and shape; and to determine the success rate of laparoscopic-assisted GIFB removal with GIFB of various characteristics.

Study design: Prospective clinical study.

Animals: Client-owned dogs (30) that underwent laparoscopic-assisted intestinal surgery (LAIS).

Methods: Dogs with GIFB obstruction underwent an AUS performed by a boarded radiologist. GIFB type, location within the gastrointestinal tract, size, and shape were recorded, as well as the presence or absence of peritoneal fluid, pneumoperitoneum, or mural changes. LAIS was attempted in all dogs. Surgical findings were compared to ultrasound findings.

Results: AUS was able to correctly determine the type, location, and shape of GIFB 96.8%, 77.42%, and 93.5% of the time, respectively. AUS had moderate accuracy (80%), at identifying adhesions, and underestimated GIFB size. LAIS was successful in 16/30 (53.3%) of cases, including 2/7 (28.6%) linear, 14/23 (60.9%) non-linear, and 1/1 (100%) gastric foreign bodies, but was not successful for GIFB near the caudal duodenal flexure (0/2, 0%).

Conclusion: Preoperative AUS was accurate in determining the type, location, and shape of GIFB. Specific linear foreign bodies were amenable to laparoscopic-assisted removal. GIFB located at the caudal duodenal flexure were not successfully removed by LAIS.

Clinical significance: Preoperative AUS is a useful diagnostic to aid in determining the suitability of a dog to undergo LAIS.

Objective: To compare the effect of two continuous intradermal suture patterns (modified Allgower-Donati [mAD] vs. horizontal mattress [SP]) on acute changes in cutaneous perfusion following closure of the skin incision in cats undergoing ovariohysterectomy.

Study design: Within animal randomized controlled trial conducted at three animal shelters.

Animals: A total of 32 cats.

Methods: Adult cats receiving elective ovariohysterectomy underwent standardized skin incisions closed with two intradermal suture patterns (mAD or SP) randomly assigned to the cranial or caudal half. All procedures were performed by an ACVS board certified surgeon. Incisional margin cutaneous perfusion was measured using a laser Doppler perfusion imager at baseline and following closure. Baseline perfusion was subtracted from post-suturing perfusion at each region obtaining a delta effect for each pattern. Incisional complications in the 30 days following surgery were also recorded.

Results: Mean (±SD) surgical time was 19.3 ± 4.1 min. Cutaneous perfusion increased by a mean of 59.7 ± 124.1 blood perfusion units (BPU) from baseline with the mAD pattern, compared with a decrease of 20.2 ± 119.9 BPU from baseline for the standard suture pattern (p < .01). No cats re-presented for incisional complications.

Conclusion: The mAD pattern resulted in improved wound margin perfusion compared with the SP pattern.

Clinical significance: The mAD pattern offers an alternative to the current standard of care intradermal pattern, maintaining the advantages of a buried pattern while improving perfusion to the wound margin.

Objective: To describe the surgical technique and report the clinical outcomes of using locking plates applied transversely across the sternum as part of sternal repair after large sternectomy.

Animals: Two client-owned dogs.

Study design: Short case series.

Methods: One dog with chest wall hemangiosarcoma and one dog with chronic extensive thoracic pyogranulomatous lesion caused by Actinomyces spp. were treated by thoracic wall resection including partial sternectomy. The defect was reconstructed with multiple techniques including a locking plate secured with screws in two opposite ribs.

Results: There were no complications related to the surgical reconstruction or implants. The first dog was euthanized at 8 months postoperatively following sudden deterioration. The second dog developed self-limiting serosanguinous discharge from 3 to 6 days postoperatively but otherwise had an uneventful recovery. No recurrence was reported 15 months post-surgery.

Conclusion: Use of a locking plate to span two opposite ribs in conjunction with other reconstructive techniques was a safe and effective method of treating large sternal wounds in these two dogs. This new surgical technique yielded excellent functional and cosmetic outcomes. Transverse locking plate application is a straightforward and promising option for large thoracic wall or sternal defects.

Objective: To report the complications and outcomes following surgical management of common calcaneal tendon (CCT) pathology in dogs.

Study design: Retrospective cohort study.

Sample population: A total of 80 dogs with CCT pathology underwent 89 surgeries.

Methods: Retrospective data were reviewed from five veterinary referral centers for dogs with CCT pathology that underwent surgical treatment (January 2011 to December 2021). Clients completed a Liverpool Osteoarthritis in Dogs (LOAD) questionnaire to assess long-term outcomes.

Results: Tendon repair with tarsocrural immobilization was performed in 46/89 limbs (51.7%), with three-loop pulley the most common suture pattern, used in 19/46 tendon repairs (41.3%). Pantarsal arthrodesis was performed in 32/89 limbs (36%) and temporary tarsocrural immobilization without tendon repair in 11/89 limbs (12.3%). Median time from surgery to final follow-up at the referral center was 10 weeks (range: 6-256 weeks). There was no difference in complication rate between tendon repair (56.5%) and pantarsal arthrodesis (42.8%) (p = .543). Tendon repair with tarsocrural immobilization had a significantly higher catastrophic complication rate (26.1%) than pantarsal arthrodesis (0%) (p = .005). A total of 23 LOAD questionnaires were returned. There was no difference in mildly affected dogs between the three surgical groups (p = .493).

Conclusion: Pantarsal arthrodesis and CCT repair surgeries had comparable short-term outcomes and complication rates. However, there is a greater risk of complications requiring revision surgery following temporary tarsocrural immobilization, with or without tendon repair, compared to pantarsal arthrodesis.

Clinical significance: The increased risk of revision surgery should be discussed with owners, considering the potential financial and treatment implications for their dogs.

Surgical limb-sparing in veterinary medicine can be defined as an intervention aimed at preserving limb function when a bone abnormality is present, namely neoplasia or a non-repairable fracture, and the affected segment of that bone needs to be removed and, most often, replaced. In some cases, the affected segment of bone is treated and reimplanted. It is mostly prevalent in the context of local tumor control while preserving limb function in veterinary surgical oncology but has also been employed for comminuted fracture repair. Importantly, this review focuses on neoplasia and non-repairable fractures wherein the bones were normal prior to the pathology and the non-affected segments of bone remain normal in the face of the pathology. Several techniques have been reported and vary based on a number of factors such as anatomic location of the pathology and method of addressing the defect created by removal of the affected bone segment. Limb-sparing techniques have been documented to have comparable survival times to limb amputation but can be fraught with mechanical and biological complications, requiring intensive long-term care and client compliance with treatment regimens. The most common complications are infection, mechanical failure, and local recurrence. Decreasing the risk of complication is the driving force for research in the field of limb sparing in dogs. The aim of this review was to compile the existing literature on surgical limb-sparing in dogs with the intent to guide clinical decision-making and inform further research on limb-sparing.

Objective: To determine the ideal location of a medial tenoscopic portal in the equine carpal flexor tendon sheath (CFTS) using contrast computed tomography (CT).

Study design: Experimental cadaver study.

Animals: A total of 20 entire forelimbs from adult Standardbred horses.

Methods: Contrast media diluted in saline was injected into the CFTS from a lateral approach before manually flexing and extending the limb 20 times to disperse the contrast solution. The limbs were placed in lateral recumbency and a capped 21-gauge 1.5 inch needle was placed approximately 5 mm proximal and 32 mm caudal to the palpable distal medial radial physis into the medial aspect of the CFTS. Contrast CT was performed followed by tenoscopy using the conventional lateral approach. Gross dissection was then performed to determine if any damage was caused by needle placement. CT images were reviewed for impingement of intrathecal structures, the cephalic vein (CV) and the flexor carpi radialis tendon (FCRT).

Results: Neither intrathecal nor macroscopic superficial damage was caused by needle placement. Impingement of the FCRT and CV, identified on CT, occurred in seven specimens (35%) and one specimen (5%), respectively.

Conclusion: The location for a medial tenoscopic portal was identified in the current study.

Clinical significance: Establishment of the location of a medial tenoscopic portal may help surgeons improve triangulation, egress and visualization of structures within the carpal sheath.

Objective: To describe the use of the lateral caudal axial pattern flap in cats for reconstructing caudodorsal trunk defects in cats, and to report complication types, complication rates, and flap outcomes.

Study design: Retrospective study.

Animals: Fourteen client-owned cats.

Methods: Medical records of cats that underwent reconstruction of caudodorsal defects using a lateral caudal axial pattern flap were reviewed retrospectively. Recorded data included signalment, cause, and dimensions of the defect, flap dimensions (length, width, percentage of tail length), intraoperative and short-term postoperative complications, and flap outcomes.

Results: The flap was used to cover defects following tumor excision in 85.7% of cats. The mean flap length relative to tail length was 61.3%. Intraoperative complications occurred in 1/14 cats (7.1%), and postoperative complications in 7/14 cats (50%). The most common complications were partial flap dehiscence (14.2%), seroma (14.2%), and edema (14.2%). In 8/14 cats (57.1%), flap healing was uncomplicated, and in 6/14 cats (42.8%), only minor complications were observed.

Conclusion: The lateral caudal axial pattern flap appears to be a valid option for closing defects in the caudodorsal region of the trunk in cats. The flap length relative to tail length was similar to values reported in dogs. Although the overall complication rate may be higher in cats, the majority of cats experienced either no complications or only minor ones.

Clinical significance: This axial pattern flap constitutes a reliable and effective reconstructive technqiue for the closure of cutaneoaus defects located in the caudodorsal region of the feline trunk.

Objective: To describe reproductive performance in Thoroughbred broodmares post-large colon resection and to compare to performance post-colopexy.

Study design: A single-institution retrospective study.

Animals: A total of 29 client-owned horses: post-large colon resection (LCR) n = 19, post-colopexy: n = 10.

Methods: Thoroughbred broodmares that survived until discharge following LCR (Group R) or colopexy (Group P) between 2006 and 2023 were included. Clinical data were collected from clinical records. Breeding and foaling data were collected from the Australian and New Zealand Studbooks. Statistical analysis were performed using Mann-Whitney U and Fisher's exact test using R software. Descriptive and postoperative reproductive data were compared between groups and a calculated nationwide average.

Results: There were no differences in any evaluated measurements of reproductive success between groups. In Group R, the first breeding season post-resection appeared less successful than the second (p = .03 [95% CI: 0.026-0.98]) or third (p = .03 [95% CI: 0.018-0.93]); however, these differences were not statistically significant after Bonferroni correction for multiple comparisons (adjusted significance threshold p < .0083) and were not observed when unserved mares were excluded. Both groups achieved similar live foal/mare served percentages when compared to Racing Australia's published data (Group R: 60.5%, Group P: 68.2%, Racing Australia: 64.3%).

Conclusion: No difference in reproductive success post-surgery was noted between techniques. Reproductive success is achievable post-large colon resection.

Clinical significance: Postoperative reproductive success should not be a factor in intraoperative decision-making when determining which preventative strategy (LCR or colopexy) is utilized. Further larger studies are required to confirm these findings and investigate possible initial reduction in reproductive success post-LCR.